Title

Trends of diabetes and hypertension as underlying primary diagnoses in end stage renal disease in Pakistan between 1990-1991 and 1997-1998 periods

Date of Award

2000

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

ln the twenty-first century more people are expected to live beyond 65 years and bear chronic diseases than ever due to the changing environment and life-style. Global incidence of diabetes and hypertension and their subsequent complications are increasing. National Health Survey of Pakistan has reported poor knowledge, lack of treatment and control for both diabetes and hypertension among people, Both diabetes and hypertension can result in an unmanageable burden of end stage renal disease (ESRD). Less than 25% of the ESRD population has an access to renal support in the form of dialysis and transplantation. Absence of registry and studies cannot help to plan forward for the emerging leading primary diagnoses in ESRD and population wide preventive measures that can be introduced for their control. This study can serve as a substitute for registry system, which is essential for planners to assess the rising burden of ESRD in Pakistan and to bring the needed interventions. Limited financial means, socio-cultural factors and limited access to health care also make patients more vulnerable to ESRD. The objective of the study were to determine changes in the distribution of diabetes and hypertension as underlying primary diagnoses in end stage renal disease between 1gg0-91 and 1gg7-gg at leading nephrological units in Pakistan. A serial cross-sectional study was undertaken at three dialysis centers (with best available records) located in three different cities of Pakistan. The study population comprised of newly registered patients of ESRD who started receiving maintenance dialysis during 1990-91 and 1997-98, and qualified the eligibility criteria. Standardized definitions were used to apply primary diagnosis on the basis of available information in. records. Structured medical abstract forms were used to retrieve data from all the eligible records of newly registered patients. Time period was the main variable to assess the trend of diabetes and hypertension as primary diagnoses in ESRD. Effect of other variables was controlled through logistic regression analysis. A sample of 373 records in 1990-91 and 692 records in 1gg7-g8 was achieved against theoretical calculation of M7 for each time period. Among ESRD patients the adjusted odds of diabetes as primary diagnosis in 1997-98 were 1.60 times when compared to ESRD patients with diabetes as primary diagnosis in 1990-91 (95% Cl for Adj. OR: 1.12-2.29). ESRD patients with diabetes as primary diagnosis were more likely to have hypertension as a concurrent disease than ESRD patients with non-diabetes as primary diagnosis (Adj. OR = 4.27,95% Cl for, Adj. OR: 2.64-6.90). ESRD patients with diabetes as PD were more likely to register at Sheikh Zayed Hospital Lahore as compared to non-diabetes as primary diagnosis when Kidney Centre Karachi was reference (Adj. OR = 1.56, 95% Cl for Adj. OR: 1.07-2.39). A comparatively older patients (Mean age 46.5, SE 0-59) of ESRD were observed in 1997-98 as compared to 1990-91 (Mean age 43-5, SE 0.82) with increasing caseload from almost all primary diagnoses in ESRD- The study showed an increasing trend of diabetes as primary diagnosis in ESRD from 1990-91 to 1997-98. The role of hypertension cannot be under estimated, especially when it had been associated as a concurrent disease in 46- 56% of ESRD patients in 1990-91 and 1997-98. The role of hypertension as a contribution to ESRD (directly and indirectly) can be as great as 63-70% in 1990- 91 and 1997-08- Appropriate preventive and curative interventions are needed to control the rising burden of ESRD especially with diabetes and hypertension as primary diagnoses in Pakistan.

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